Orthorexia: combating the spiral of the imaginary risk

To treat orthorexia, you must focus on the intention as part of the eating behaviour of sufferers and on the authenticity of eating. Part two of our interview with the dietician Nicolas Sahuc.

What are the root causes of orthorexia?

To understand the root causes of orthorexia, we must focus on more the intention behind the sufferer’s actions, instead of on his behaviour. It only becomes a real disease, when orthorexia dictates the way you think, preventing the individual from functioning “normally”, which in turn has an impact on the sufferer’s life.

In our consultations, we became aware of the fact that orthorexia is facilitated by the nutritional discourse of certain vloggers and coachers, people who believe in “restoring a balance”. But these individuals are not necessarily scientifically or medically trained.

Orthorexia is also fuelled by various dietary fears: excessive food security, industrialisation, a lack of authentic, too much information and disinformation, body images that are foisted upon us by publicity, the fact that certain health professionals do not listen to patients, scientific (which constantly raises new questions) and medical (which better repairs the body) progress and so on.

This “crisis of right and wrong” and of something that is essentially an abstraction creates a lot of uncertainty, making people worry about the risks they run when eating. Paradoxically enough, reducing the risk only makes the fear of this risk worse. In other words, orthorexia slowly sinks into a spiral of an imaginary risk, from which it is difficult to extricate yourself.

How to treat orthorexia?

First of all, you have to establish an accurate diagnosis and avoid making the wrong diagnosis. Any person who is obsessed with clean eating, whether for ethical, philosophical or political reasons, exhibits pathological behaviour. Orthorexia has many traits in common with OCD (obsessive-compulsive disorder) or anorexia, both of which require special medical treatment and guidance.

In effect, anyone can suffer from orthorexia, whether you are small, tall, fat or thin. It may occur before, at the same time, or after an eating disorder.

It is also very hard to detect, especially because the issue may potentially resolve itself, often under pressure of the people who live with the sufferer.

Our analysis of the intention behind the behaviour revealed that certain orthorexics feel neither excluded, nor do they feel that they are missing out on something. On the contrary even, this lifestyle choice makes them feel happier.

The best dietary approach therefore consists of avoiding any discussions about the orthorexic’s convictions (which are too difficult to decipher anyway). Instead the emphasis should be on an explanatory dietary approach, based on non-normative nutritional knowledge, on an understanding of how the body works. This explains what to do and also offers a standard set of information about how the body works.

This basic information usually reassures the sufferer. Obviously, this should be combined with cognitive and behavioural therapy, focusing on obsessions and convictions, to help alter the quality of life. Everything depends on the evolution of psychiatric comorbidities. Where possible, a day hospital admission in a treatment centre for eating disorders with a differentiated diagnosis is the best option for a good follow-up.

Short biography

Master in Practical Philosophy and in medical and hospital Ethics

An independent dietician working at the University Hospital of Montpellier

An expert on anorexia and bulimia, obesity and sport

A former expert of the programme “Tout une histoire” with Sophie Davant

A former columnist of “Mille & Une vies”, with Frédéric Lopez on France2 Télévision

Attend the lectures of Nicolas Sahuc on eating disorders. Find out more here